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What the Star Ratings Measure
CMS evaluates plans across five major domains:
- Staying Healthy: Screenings, tests, and vaccines (preventive care quality)
- Managing Chronic Conditions: Monitoring and care for conditions like diabetes, heart disease
- Plan Responsiveness: Complaints, customer service, member experience
- Member Experience: Survey results from enrolled members
- Drug Plan: Drug safety, pricing accuracy, and member experience with Part D
Star Rating Scale Explained
- ⭐⭐⭐⭐⭐ (5 Stars): Excellent — Special Enrollment Period privilege; can join any time of year
- ⭐⭐⭐⭐ (4 Stars): Above average — solid choice
- ⭐⭐⭐ (3 Stars): Average performance — consider alternatives
- ⭐⭐ (2 Stars): Below average — CMS issues improvement warnings
- ⭐ (1 Star): Low performance — at risk of being removed from Medicare
The 5-Star Special Enrollment Benefit
If a plan earns 5 stars, you can switch into it any time between December 8 and November 30 of the following year — you don’t have to wait for AEP. This is a powerful benefit if a 5-star plan becomes available in your county.
See also: Best Plans • Enrollment Guide